Coupling proteins to a modified polysaccharide

ABSTRACT

The invention relates to a method for coupling proteins to a starch-derived modified polysaccharide. The binding interaction between the modified polysaccharide and the protein is based on a covalent bond which is the result of a coupling reaction between the terminal aldehyde group or a functional group of the modified polysaccharide molecule resulting from the chemical reaction of this aldehyde group and a functional group of the protein which reacts with the aldehyde group or with the resulting functional group of the polysaccharide molecule. The bond directly resulting from the coupling reaction can be optionally modified by a further reaction to the aforementioned covalent bond. The invention further relates to pharmaceutical compositions that comprise conjugates formed in this coupling process and to the use of conjugates and compositions for the prophylaxis or therapy of the human or animal body.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a National Stage application under 35 U.S.C. § 371and claims benefit under 35 U.S.C. § 119(a) of International ApplicationNo. PCT/EP03/02083 having an International Filing Date of Feb. 28, 2003,which claims the benefit of priority of German Patent Application Ser.No. 10209821.2 having a filing date of Mar. 6, 2002.

The rapid development in genetic engineering in recent decades has ledto the new identification of a large number of genes for proteins havingpotential therapeutic benefits and to the possibility of producingwithout difficulty the corresponding gene products, pure or nearly purein relatively large quantities, with the aid of biological expressionsystems.

However, it has emerged that the use of such proteins in practice, e.g.in diagnosis, therapy and for biotransformations, frequently meets withdifficulties because the stability and solubility properties thereof,especially at physiological pH values, are often unsatisfactory. Twoexamples of such proteins are tumor necrosis factor TNF-α orinterleukin-2.

Solubility problems additionally occur very frequently in the expressionof glycoproteins in prokaryotic systems such as E. coli, because theyare then expressed without the natural glycosylation, resulting in aconsiderably reduced solubility in some cases. This may make itnecessary to use considerably more costly eukaryotic expression systems.

On therapeutic use in the body, many proteins are very quickly removedfrom the bloodstream or degraded. Systemically administered proteinshaving a molecular weight of more than about 70 kDa may be removed fromthe circulation by the reticuloendothelial system or specificinteractions with cellular receptors. Smaller proteins having amolecular weight of less than about 70 kDa may in addition be removed toa large extent by the glomerular filtration in the kidney (exclusionlimit about 70 kDa).

An approach followed recently to eliminate the described problemsconsists in coupling such problematic proteins to biocompatible polymerswith good solubility in water, such as, for example, polyethylene glycoland dextran. On the one hand, it is possible by the coupling to increasethe molecular weight above the threshold of 70 kDa, so that the plasmaresidence time of smaller proteins can be drastically increased, and onthe other hand the solubility in aqueous medium can be improved by thehydrophilic polymer portion.

Further, usually beneficial effects which may be connected with couplingof proteins to such polymers are based on the masking of proteaserecognition sites and antigenic determinants on the protein molecule bythe bound polymer. On the one hand, it is possible thereby for thetherapeutic proteins substantially to escape proteolytic degradation,and on the other hand there is substantial suppression of the inductionof allergenic reactions by the exogenous therapeutic protein. Beyond theincrease in molecular weight, proteins are thus protected by thepresence of a polymer from enzymatic degradation and, in addition, oftenfrom thermal denaturation. In many cases, the stability and in vivohalf-life of the proteins is markedly increased, and the immunogenicityand antigenicity falls, thereby.

To date, most modifications have been carried out with polyethyleneglycol or dextran, with PEG being generally preferred because it affordssimpler products.

Dextran couplings have been described for only a few proteins such as,for example, streptokinase, plasmin, hemoglobin or aprotinin. However,dextran conjugates often show high allergenicity, presumably caused bydextran degradation products, a low metabolic stability and, in manycases, low yields in the coupling reactions. This has led to none ofthese dextran coupling products being approved as yet for therapeuticuse in humans or animals.

Derivatizations with PEG have been carried out considerably morefrequently, so that this method can now be regarded as standard forincreasing the molecular weight of proteins. Some of these derivativesare in various phases of clinical trials or are already approved in theUSA. PEG-hemoglobin is currently in phase III, as is a PEG adduct ofsuperoxide dismutase (SOD), which is the protein which has beeninvestigated most in relation to polymer couplings. PEG-coupledasparaginase is already employed in the therapy of acute lymphocyticleukemia. In 2001, PEG-interferon-α was approved for the treatment ofhepatitis C patients.

On use of these PEG conjugates, however, side effects ranging fromunpleasant to dangerous have also been reported, such as pruritis,hypersensitivity reactions and pancreatitis. In addition, the biologicalactivity of the proteins after PEG coupling is often very low and themetabolism of the degradation products of PEG conjugates is stillsubstantially unknown and possibly represents a health risk.

WO 99/49897 describes conjugates of hemoglobin which are formed byreacting the aldehyde groups of oxidatively ring-opened polysaccharidessuch as hydroxyethylstarch or dextran with primary amine groups of theprotein. However, in this case, the employed polysaccharides act aspolyfunctional reagents, resulting in a very heterogeneous productmixture with properties which are difficult to adjust.

U.S. Pat. No. 6,083,909 describes a process for coupling selectivelyoxidized hydroxyethylstarch to hemoglobin in DMSO. Our investigationshave shown, however, that the desired product is not obtained under thestated conditions, because hemoglobin is denatured in DMSO and thusloses its biological activity.

There is thus still a need for physiologically well toleratedalternatives to dextran- or PEG-coupled proteins, with which thesolubility of proteins can be improved or the plasma residence time ofthe proteins can be increased.

It is therefore an object of the invention to provide such alternativesand to develop simple and efficient processes for preparing suchalternative protein derivatives.

This object is achieved according to the invention byhydroxyalkylstarch-protein conjugates which are characterized in thatthe binding interaction between the hydroxyalkylstarch molecule and theprotein is based on a covalent bonding which is the result of a couplingreaction between the terminal aldehyde group, or a functional groupderived from this aldehyde group by chemical reaction, of thehydroxyalkylstarch molecule and a functional group, which is able toreact with this aldehyde group or functional group derived therefrom ofthe hydroxyalkylstarch molecule, of the protein, where the bondingresulting directly in the coupling reaction can be modified whereappropriate by a further reaction to give the abovementioned covalentbonding.

The invention further includes pharmaceutical compositions whichcomprise these conjugates, and the use of these conjugates andcompositions for the prophylactic or therapeutic treatment of the humanor animal body, and methods for preparing these conjugates andcompositions.

It has surprisingly been found that the reactions described above can,with a suitable choice of the conditions, be carried out in aqueoussolution, thus allowing the biological activity of the proteins in manycases to be completely or partly retained.

The aqueous reaction medium for the coupling reaction is in this casepreferably water or a mixture of water and an organic solvent, where theproportion of water in the mixture is at least about 70% by weight,preferably at least about 80% by weight, more preferably at least about90% by weight.

The molar ratio of hydroxyalkylstarch (HAS) to protein in the couplingreaction is usually about 20:1 to 1:1, preferably about 5:1 to 1:1.

The remaining biological activity of the inventivehydroxyalkylstarch-protein conjugates, based on the initial activity ofthe protein, is usually at least 40%, preferably at least 50%, morepreferably at least 70%, even more preferably at least 90%, mostpreferably at least 95%.

The hydroxyalkylstarch (HAS) employed according to the invention can beprepared by a known method, e.g. hydroxyalkylation of starch at the C₂and/or C₆ position of the anhydroglucose units with alkylene oxide or2-chloroalkanol, e.g. 2-chloroethanol (see, for example, U.S. Pat. No.5,218,108 for the hydroxyethylation of starch), with various desiredmolecular weight ranges and degrees of substitution. It is also possibleto employ any preparations obtainable commercially. The definition ofthe alkyl grouping in “hydroxyalkylstarch”, as used herein, includesmethyl, ethyl, isopropyl and n-propyl, with particular preference forethyl. A substantial advantage of HES is that it is already approved bythe authorities as biocompatible plasma expander and is employedclinically on a large scale.

The average molecular weight of the hydroxyalkylstarch can be in therange from about 3 kDa to several million daltons, preferably about 4kDa to about 1000 kDa, more preferably in the range from about 4 kDa toabout 50 kDa or in the range from about 70 kDa to about 1000 kDa,particularly preferably about 130 kDa. For coupling to small proteins,the average molecular weight of the hydroxyalkylstarch is preferablychosen so that the abovementioned threshold of 70 kDa is exceeded withthe conjugates, whereas for coupling to large proteins the molecularweight of the hydroxyalkylstarch will preferably be in the lower regionof said range. Since coupling is possible at a plurality of sites in aprotein, it may also be advantageous to couple a plurality of smallpolymer chains, instead of one of high molecular weight. The degree ofsubstitution (ratio of the number of modified anhydroglucose units tothe number of anhydroglucose units in total) may likewise vary and willfrequently be in the range from about 0.2 to 0.8, preferably about 0.3to 0.7, more preferably about 0.5. (Note: the numbers relate to the“degree of substitution”, which is between 0 and 1). The ratio of C₂ toC₆ substitution is normally in the range from 4 to 16, preferably in therange from 8 to 12.

These parameters can be adjusted by known methods. Experience with theuse of hydroxyethylstarch (HES) as blood substitute has shown that theresidence time of HES in the plasma depends on the molecular weight andthe degree of substitution and type of substitution (C₂ substitution orC₆ substitution), with a higher molecular weight, a higher degree ofsubstitution and a higher proportion of C₂ substitution increasing theresidence time.

These relationships also apply to the inventivehydroxyalkylstarch-protein conjugates, so that the residence time of aparticular conjugate in the plasma can be adjusted via the proportion ofpolysaccharide.

Hydroxyethylstarch products with an average molecular weight of 130 kDaand a degree of substitution of 0.5, and with an average molecularweight of 200 kDa and a degree of substitution of 0.25, have alreadybeen used clinically as blood substitutes and are also suitable for usein the present invention.

The protein suitable in the present invention is in principle anyprotein which has the necessary functional group, e.g. a free aminogroup, thiol group or carboxyl group, for reacting with the functionalgroup of the HAS molecule.

A desired functional group can be introduced also by reacting theprotein with a suitable, physiologically tolerated, bifunctional linkermolecule. The remaining reactive functional group of the coupled-onlinker molecule is then likewise regarded as “reactive functional groupof the protein” for the purposes of the present invention.

Suitable linker molecules comprise at one end a grouping able to enterinto a covalent bonding with a reactive functional group of the protein,e.g. an amino, thiol, or carboxyl group, and at the other end a groupinglikewise able to enter into a covalent bonding with the terminalaldehyde group or a functional group derived therefrom by chemicalreaction, e.g. a carboxyl group, activated carboxyl group, amino orthiol group. Between the two functional groups of the linker moleculethere is a biocompatible bridging molecule of suitable length, e.g. agrouping derived from an alkane, an (oligo)alkylene glycol grouping oranother suitable oligomer grouping. Preferred groupings able to reactwith amino groups are, for example, N-hydroxysuccinimide esters,sulfo-N-hydroxysuccinimide esters, imido esters or other activatedcarboxyl groups; preferred groupings able to react with thiol groupsare, for example, maleimide and carboxyl groups; preferred groupingsable to react with aldehyde or carboxyl groups are, for example, aminoor thiol groups.

Examples of linker molecules for connecting SH and NH functions are:

AMAS (N-α(maleimidoacetoxy)succinimide ester) BMPS(N-β(maleimidopropyloxy)succinimide ester) GMBS(N-γ(maleimidobutyryloxy)succinimide ester) EMCS(N-ε(maleimidocaproyloxy)succinimide ester) MBS(m-(maleimidobenzoyl)-N-hydroxysuccinimide ester) SMCC (succinimidyl4-(N-maleimidomethyl)cyclo- hexane-1-carboxylate) SMPB (succinimidyl4-(p-maleimidophenyl)butyrate) SPDP (succinimidyl 3-(2-pyridyldithio)proprionate) Sulfo-(N-γ(maleimidobutyryloxy)sulfosuccinimide GMBS ester) Sulfo-(N-ε(maleimidocaproyloxy)sulfosuccinimide EMCS ester).

Examples of linker molecules for connecting SH and SH functions are:

BMB (1.4-bis-maleimidobutane) BMDB(1.4-bis-maleimido-2,3-dihydroxybutane) BMH (bis-maleimidohexane) BMOE(bis-maleimidoethane) DTME (dithio-bis-maleimidoethane) HBVS(1.6-hexane-bis-vinyl sulfone) BM(PEO)₃ (1.8-bis-maleimidotriethyleneglycol) BM(PEO)₄ (1.11-bis-maleimidotetraethylene glycol).

Examples of linker molecules for connecting NH and NH functions are:

BSOCOES (bis-(2-succinimidyloxycarbonyloxy)ethyl) sulfone BS³(bis-(sulfosuccinimidyl) suberate) DFDNB (1.5-difluoro-2,4-nitrobenzene)DMA (dimethyl adipimidate HCl)) DSG (disuccinimidyl glutarate) DSS(disuccinimidyl suberate) EGS (ethylene glycol bis(succinimidylsuccinate).

Examples of linker molecules for connecting SH and CHO functions are:

BMPH (N-(β-maleimidopropionic acid)hydrazide TFA) EMCA(N-(ε-maleimidocaproic acid)hydrazide) KMUH (N-(κ-maleimidoundecanoicacid)hydrazide) M₂C₂H (4-(N-maleimidomethyl)cyclohexane-1-carboxylhydrazide HCl) MPBH (4-(4-N-maleimidophenyl)butyric acidhydrazide HCl) PDPH (3-(2-pyridyldithio)propionylhydrazide).

An example of a linker molecule for connecting SH and OH functions is

-   PMPI (N-(p-maleimidophenyl)isocyanate).

Examples of linker molecules for converting an SH function into a COOHfunction are

BMPA (N-β-maleimidopropionic acid) EMCH (N-β-maleimidocaproic acid) KMUA(N-κ-maleimidoundecanoic acid).

Examples of linker molecules for converting an NH function into a COOHfunction are MSA (methyl N-succinimidyl adipate) or longer-chainhomologues thereof or corresponding derivatives of ethylene glycol.

Examples of linker molecules for converting a COOH function into an NHfunction are DAB (1.4-diaminobutane) or longer-chain homologues thereofor corresponding derivatives of ethylene glycol.

An example of a linker molecule which reacts with an amino group of amolecule and provides a protected amino group at a larger distance fromthis molecule to avoid steric hindrance isTFCS(N-ε(trifluoroacetylcaproyloxy)-succinimide ester).

Further suitable linker molecules are known to skilled workers andcommercially available or can be designed as required and depending onthe functional groups present and desired in the HAS and the protein tobe coupled on, and be prepared by known methods.

The term “protein” for the purposes of the present invention is intendedto include every amino acid sequence which comprises at least 9-12 aminoacids, preferably at least 15 amino acids, more preferably at least 25amino acids, particularly preferably at least 50 amino acids, and alsoinclude natural derivatives, e.g. pre or proforms, glycoproteins,phosphoproteins, or synthetic modified derivatives, e.g. fusionproteins, neoglycoproteins, or proteins modified by genetic engineeringmethods, e.g. fusion proteins, proteins with amino acid exchanges tointroduce preferred coupling sites.

For the prophylactic or therapeutic treatment of the human or animalbody, the relevant protein will carry out a particular desired functionin the body. The protein therefore preferably has, for example, aregulatory or catalytic function, a signal transmitting or transportfunction or a function in the immune response or induction of an immuneresponse.

The protein may be selected for example from the group composed ofenzymes, antibodies, antigens, transport proteins, bioadhesion proteins,hormones, growth factors, cytokines, receptors, suppressors, activators,inhibitors or a functional derivative or fragment thereof. “Functionalderivative or fragment” means in this connection a derivative orfragment which has retained a desired biological property or activity ofthe parent molecule in whole or in part, e.g. to the extent of at least10-30%, preferably more than 50%, even more preferably more than 70%,most preferably more than 90%. Particularly preferred examples of such afragment are antibody fragments.

Specific examples are α-, β- or γ-interferon, interleukins, e.g. IL-1 toIL-18, growth factors, e.g. epidermal growth factor (EGF), plateletgrowth factor (PDGF), fibroblast growth factor (FGF), brain-derivedgrowth factor (BDGF), nerve growth factor (NGF), B-cell growth factor(BCGF), brain-derived neurotrophic growth factor (BDNF), ciliaryneurotrophic factor (CNTF), transforming growth factors, e.g. TGF-α orTGF-β, colony-stimulating factors (CSF), e.g. GM-CSF, G-CSF, BMP (bonemorphogenic proteins), growth hormones, e.g. human growth hormone, tumornecrosis factors, e.g. TNF-α or TNF-β, somatostatin, somatotropin,somatomedins, serum proteins, e.g. clotting factors II-XIII, albumin,erythropoietin, myoglobin, hemoglobin, plasminogen activators, e.g.tissue plasminogen activator, hormones or prohormones, e.g. insulin,gonadotropin, melanocyte-stimulating hormone (α-MSH), triptorelin,hypothalamus hormones, e.g. antidiuretic hormones (ADH) and oxytocin,and liberins and statins, parathyroid hormone, thyroid hormones, e.g.thyroxine, thyrotropin, thyroliberin, prolactin, calcitonin, glucagon,glucagon-like peptides (GLP-1, GLP-2, etc.), exendins, e.g. exendin-4,leptin, vasopressin, gastrin, secretin, integrins, glycoprotein hormones(e.g. LH, FSH, etc.), pigmentary hormones, lipoproteins andapolipoproteins, e.g. Apo-B, Apo-E, Apo-L_(a), immunoglobulins, e.g.IgG, IgE, IgM, IgA, IgD or a fragment thereof, hirudin, tissue pathwayinhibitor, plant proteins, e.g. lectin or ricin, bee venom, snakevenoms, immunotoxins, antigen E, butroxobina, alpha-proteinaseinhibitor, ragweed allergen, melanin, oligolysine proteins, RGD proteinsor, where appropriate, corresponding receptors for one of theseproteins; or a functional derivative or fragment of one of theseproteins or receptors.

Suitable enzymes may be selected for example from the groups ofcarbohydrate-specific enzymes, proteolytic enzymes, oxidases,oxidoreductases, transferases, hydrolases, lyases, isomerases, kinasesand ligases. Specific, non-restrictive examples are asparaginase,arginase, arginine deaminase, adenosine deaminase, glutaminase,glutaminase-asparaginase, phenylalanine ammonia-lyase, tryptophanase,tyrosinase, superoxide dismutase, an endotoxinase, a catalase,peroxidase, kallikrein, trypsin, chymotrypsin, elastase, thermolysin, alipase, a uricase, adenosine diphosphatase, purine-nucleosidephosphorylase, bilirubin oxidase, a glucose oxidase, glucodase,gluconate oxidase, galactosidase, glucocerebrosidase, glucuronidase,hyaluronidase, tissue factor, a tissue plasminogen activator,streptokinase, urokinase, MAP kinases, DNAses, RNAses, lactoferrin, andfunctional derivatives or fragments thereof.

As mentioned above, the functional group of the HAS molecule involved inthe coupling reaction is the terminal aldehyde group or a group derivedtherefrom by chemical reaction.

One example of such a chemical reaction is the selective oxidation ofthis aldehyde group with a mild oxidizing agent such as, for example,iodine, bromine or some metal ions, or else by means of electrochemicaloxidation to a carboxyl group or activated carboxyl group, e.g. anester, lactone, amide, with the carboxyl group being converted whereappropriate in a second reaction into the activated derivative. Thiscarboxyl group or activated carboxyl group can then be coupled to aprimary amino or thiol group of the protein to form an amide linkage orthioester linkage.

In a particularly preferred preparation method, this aldehyde group isselectively oxidized with a molar excess of iodine, preferably in amolar ratio of iodine to HAS of from 2:1 to 20:1, particularlypreferably about 5:1 to 6:1, in aqueous basic solution. In the optimizedmethod described in example 1, initially an amount of hydroxyalkylstarchis dissolved in hot distilled water, and somewhat less than 1 moleequivalent of aqueous iodine solution, preferably in a concentration ofabout 0.05-0.5N, particularly preferably about 0.1N, is added. Afterthis, an aqueous NaOH solution in a molar concentration which is about5-15 times, preferably about 10 times, that of the iodine solution isslowly added dropwise, at intervals of a plurality of minutes, to thereaction solution until the solution starts to become clear again afterthe addition. Somewhat less than 1 mole equivalent of the above aqueousiodine solution is again added to the reaction solution, the dropwiseaddition of the NaOH solution is resumed, and the addition of iodine andNaOH are repeated until approximately 5.5-6 mole equivalents of iodinesolution and 11-12 mole equivalents of NaOH solution, based on thehydroxyalkylstarch, have been added. The reaction is then stopped, thereaction solution is desalted, e.g. by dialysis or ultrafiltration,subjected to a cation exchange chromatography, and the reaction productis obtained by lyophilization. In this method, virtually quantitativeyields are achieved irrespective of the molecular weight of the HAS.

In a further particularly preferred embodiment, the selective oxidationtakes place with alkaline stabilized solutions of metal ions, e.g. Cu⁺⁺or Ag⁺, likewise in approximately quantitative yields (example 2). It ispreferred in this case to employ an approximately 3-10 times molarexcess of the oxidizing agent.

The selectively oxidized hydroxyalkylstarch (ox-HAS) which has beenformed is subsequently reacted in the presence of an activating reagentwith a free amino group of the desired protein to form an amide linkage.Examples of suitable activating reagents are N-hydroxysuccinimide,N-hydroxyphthalimide, thiophenol, p-nitrophenol, o,p-dinitrophenol,trichlorophenol, trifluorophenol, pentachlorophenol, pentafluorophenol,1-hydroxy-1H-benzotriazole (HOBt), HOOBt, HNSA, 2-hydroxypyridine,3-hydroxypyridine, 3,4-dihydro-4-oxobenzotriazin-3-ol,4-hydroxy-2,5-diphenyl-3(2H)-thiophenone 1,1-dioxide,3-phenyl-1-(p-nitrophenyl)-2-pyrazolin-5-one),[1-benzotriazolyl-N-oxytris(dimethylamino)phosphoniumhexafluoro-phosphate] (BOP),[1-benzotriazolyloxytripyrrolidino-phosphonium hexafluorophosphate(PyBOP), [O-(benzotriazol-1-yl)-N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HBTU),[O-(benzotriazol-1-yl)-N,N,N′,N′-tetramethyluronium tetrafluoroborate(TBTU), [O-(benzotriazol-1-yl)-N,N,N′,N′-bis(pentamethylene)uroniumhexafluorophosphate,[O-(benzotriazol-1-yl)-N,N,N′,N′-bis(tetramethylene)uroniumhexafluorophosphate, carbonyldiimidazole (CDI), or preferablycarbodiimides, e.g. 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide (EDC),dicyclohexylcarbodiimide (DCC), diisopropylcarbodiimide (DIPC),particularly preferably EDC. In contrast to conventional methodsdescribed in the literature for similar coupling reactions, it hassurprisingly been found in this connection that on use of a carbodiimideas a rule the use of otherwise obligatory further activators such astriazoles, e.g. HOBt, is unnecessary or even makes the yields worse. Inthe inventive coupling of ox-HES to various model compounds in thepresence of EDC and absence of HOBt by contrast it was possible toachieve high yields substantially irrespective of the molecular weightof the HES (see examples).

Instead of the reaction of the carboxyl group or activated carboxylgroup with a free primary amino group of the protein (e.g. of a lysineor arginine residue), an analogous reaction with a thiol group (of acysteine) of the protein is also possible in principle. However, it mustbe taken into account in this connection that cysteines are usuallyinvolved in S—S bridges and are therefore not available for a couplingreaction. If, on the other hand, free cysteines are present, theyfrequently play an important part in catalysis or are involved in thecontact site of subunits. A modification of these cysteines will thenresult in partial or complete loss of the biological activity. Thisproblem could be eliminated by introducing free cysteines byconventional genetic engineering methods such as, for example directedmutagenesis or chemical peptide synthesis at those sites in the proteinwhich are known to play no part in the activity. Optimal control of thecoupling site is possible in this way. Targeted introduction of otherreaction amino acids, e.g. Lys, His, Arg, Asp, Glu, into the proteinwould also be possible in the same way.

The reactive group of the hydroxyalkylstarch molecule can also be anamine or thiol group produced by chemical reaction of the terminalaldehyde group. For example, a reductive amination of the aldehyde groupcan be carried out by reaction with ammonia in the presence of hydrogenand a catalyst or in the presence of sodium cyanoborohydride. Theresulting amino or thiol group can then react with a free carboxyl groupof the protein (e.g. of an optionally activated glutamic or asparticacid) to form an amide or thioester linkage.

A further possibility is for the terminal aldehyde group of thehydroxyalkylstarch molecule or a functional group derived therefrom bychemical reaction also to be reacted with a suitable physiologicallytolerated bifunctional linker molecule. In this case, the “functionalgroup derived from the terminal aldehyde group of the hydroxyalkylstarchmolecule by chemical reaction” for the coupling reaction is theremaining reactive functional group of the bifunctional linker moleculewith which the terminal aldehyde group or the functional group derivedtherefrom has been reacted. It is possible in this way likewise toconvert the terminal aldehyde group into a desired functional group.

Suitable linker molecules comprise at one end a group able to enter intoa covalent bonding with the terminal aldehyde group or a functionalgroup derived therefrom by chemical reaction, e.g. a carboxyl group,activated carboxyl group, amino or thiol group, and at the other end agroup able to enter into a covalent bonding with a reactive functionalgroup of the protein, e.g. an amino, thiol or carboxyl group. Betweenthe two functional groups of the linker molecule there is abiocompatible bridging molecule of suitable length, e.g. a groupingderived from an alkane, an (oligo)alkylene glycol grouping or anothersuitable oligomer grouping. Preferred groupings able to react with aminogroups are, for example, N-hydroxysuccinimide esters,sulfo-N-hydroxysuccinimide esters, imido esters or other activatedcarboxyl groups; preferred groupings able to react with thiol groupsare, for example, maleimide and carboxyl groups; preferred groupingsable to react with aldehyde or carboxyl groups are, for example, aminoor thiol groups.

A number of specific, non-restrictive examples of suitable linkermolecules have already been indicated above with reference to theconjugation of linker molecules to the protein.

In an alternative inventive coupling method of the present invention,the terminal aldehyde group is reacted directly with a primary aminogroup (e.g. of a lysine or arginine residue or of the N-terminus) of theprotein to form a Schiff's base. The formed Schiff's base is, subsequentor parallel thereto, reduced by reaction with a suitable reducing agent,resulting in a bonding which is stable in aqueous medium between proteinand HAS. Preferred reducing agents are sodium borohydride, sodiumcyanoborohydride, organic boron complexes, e.g. a4-(dimethylamino)pyridine-boron complex, N-ethyldiisopropylamine-boroncomplex, N-ethylmorpholine-boron complex, N-methylmorpholine-boroncomplex, N-phenylmorpholine-boron complex, lutidine-boron complex,triethylamine-boron complex, trimethylamine-boron complex; suitablestereoselective reducing agents are, for example, sodium triacetateborohydride, sodium triethylborohydride, sodium trimethoxyborohydride,potassium tri-sec-butylborohydride (K-Selectride), sodiumtri-sec-butylborohydride (N-Selectride), lithiumtri-sec-butylborohydride (L-Selectride), potassium triamylborohydride(KS-Selectride) and lithium triamyl-borohydride (LS-selectride).

The yields can be improved by suitable variation of the reactionconditions. Parameters for such optimization tests are the pH of thereaction mixture (possible protein degradation by alkaline borohydride),temperature and duration of the incubation, and nature of the reducingagent for the one-pot reaction. A further alternative is the possibilityof carrying out the reaction in two steps, in which case an immobilizedreducing agent can be employed for the reduction step.

The products of the coupling reaction can be investigated by knownmethods, and the coupling efficiency can be established. Thus, forexample, the free primary amino groups in the protein can be determinedbefore and after the coupling with trinitrobenzenesulfonic acid (Habeeb,ASAF, Anal. Biochem. 14, 328-336 (1966)). The coupling yield ofreactions involving primary amines could also be established byderivatization of the unreactive amines with fluorescamine anddetermination of the fluorescence. The molecular weight distribution canbe established by SDS-PAGE and gel permeation. The protein content inthe conjugate can be detected by SDS-PAGE and subsequent silverstaining, while the saccharide content can be established by aglycan-specific staining of the bands separated by SDS-PAGE afterblotting onto a membrane. Quantitative glycan determination is alsopossible. Exact identification of the coupling site on the protein ispossible by peptide mapping and/or MALDI-TOF mass spectroscopy orelectrospray ionization mass spectroscopy. It is possible in this way tooptimize the coupling and to predetermine the molecular weightdistribution and possibly (e.g. if the reactive groups on the proteindiffer in reactivity) even the coupling site of the products.

The conjugates of the present invention can where appropriate beemployed as such or in the form of a pharmaceutical composition for theprophylactic or therapeutic treatment of the human or animal body.

Compositions of this type include a pharmaceutically effective amount ofa conjugate of the invention as active ingredient, and apharmaceutically suitable carrier and, where appropriate, othertherapeutic or pharmaceutical ingredients or excipients. Excipients mayinclude for example diluents, buffers, flavorings, binders,surface-active agents, thickeners, lubricants, preservatives (includingantioxidants) and substances which serve to make the formulationisotonic with the blood of the intended recipient. A pharmaceuticallyeffective amount is the amount sufficient to display on single ormultiple administration a desired beneficial effect during a treatmentto alleviate, cure or prevent a pathological condition. Apharmaceutically acceptable carrier is a carrier which is compatibleboth with the active pharmaceutical ingredient and with the patient'sbody.

The form of the composition will vary depending on the desired orsuitable administration route. A preferred route is parenteraladministration, e.g. subcutaneous, intramuscular, intravenous,intraarterial, intraarticular, intrathecal, extradural injection or,where appropriate, infusion. Intranasal, intratracheal or topicaladministration is also possible. Topical administration of growthfactors conjugated according to the invention might for example speed upwound healing. The pharmaceutical compositions may beneficially besupplied in the form of a dosage unit and be produced by any method wellknown in the pharmacy sector.

The conjugates of the present invention can also be employed in allother sectors in which other protein-polymer conjugates, e.g.PEG-protein conjugates, have been used. Some specific, non-restrictiveexamples are the use of an HAS-protein conjugate as immobilized catalystor reactant for a reaction in heterogeneous phase or as a columnmaterial for (immuno)affinity chromatography. Further possible uses willbe plainly evident to the skilled worker with knowledge of theproperties disclosed herein of the inventive HAS-protein conjugates.

The following examples are intended to explain the invention in moredetail without, however, restricting it thereto. In particular,analogous reactions can also be carried out with hydroxymethylstarch andhydroxy-propylstarch, and similar results can be achieved.

EXAMPLE 1

Selective Oxidation of Hydroxyethylstarch (HES) with Iodine

10 g of HES-130 kDa were dissolved in 12 ml of deionized water byheating in a round-bottomed flask. 2 ml of an 12 solution (0.1N) wereadded to this solution. A pipette with 2 ml of 1.0N NaOH was connectedto the flask via a 2-way connector, and the NaOH solution was addeddropwise at about 1 drop every 4 minutes. The solution was decolorizedafter addition of approximately 0.2 ml of the NaOH solution and, at thistime, a second portion of 2 ml of 0.1N iodine solution was added. Thereaction was complete after addition of a total of 14 ml of iodinesolution and 2.8 ml of NaOH solution. The reaction mixture was thendialyzed against deionized water.

Lactonization:

The partially desalted solution was subjected to a chromatography on acation exchange column (Amberlite IR-120, H⁺ form) in order to convertthe aldonate groups into aldonic acid groups. Subsequently, the waterwas removed by lyophilization, and thus the lactone form was obtained.

Determination of the Degree of Oxidation:

1 ml of alkaline copper reagent (3.5 g of Na₂PO₄, 4.0 g of K Na tatratein 50 ml of H₂O, plus 10 ml of 1N NaOH, 8.0 ml of 10% strength(weight/volume) CuSO₄ solution and 0.089 g of K iodate in 10 ml of H₂O,after addition of 18 g of Na sulfate, make up to 100 ml) are pipetted ineach case into 1 ml of sample solution under an N₂ atmosphere. Themixture is heated at 100° C. for 45 minutes. After cooling, 0.2 ml of2.5% strength KI solution and 0.15 ml of 1 M H₂SO₄ are added. After 5min, 1 drop of phenol red indicator solution (1% weight/volume) isadded, and titration is carried out with 5 mM Na₂S₂O₃ solution until thecolor disappears. The concentration of unreacted aldehyde groups can becalculated from the consumption of titrant.

An approximately quantitative yield was achieved (>98%). It is possibleby this procedure to oxidize hydroxyethylstarches with higher molecularweight (e.g. 130 kDa, 250 kDa, 400 kDa) just like hydroxyethylstarcheswith lower molecular weight (e.g. 10 kDa, 25 kDa, 40 kDa), in similarlyhigh yields.

EXAMPLE 2

Selective Oxidation of HES with Cu²⁺ Ions

A solution of 0.24 mmol of HES-130 kD was prepared in 10 ml of deionizedwater with heating. This solution was heated in a 100 ml round-bottomedflask to a temperature of 70-80° C., and 1.17 mmol of stabilized Cu²⁺(e.g. Rochelle salt as stabilizer or other stabilizers) and diluteaqueous NaOH solution was added (final concentration 0.1N NaOH). Thetemperature was then raised to 100° C., and the reaction was allowed toproceed until a reddish color had appeared. The reaction was stopped andthe reaction mixture was cooled to 4° C. The reddish precipitate wasremoved by filtration. The filtrate was dialyzed against deionized waterand then converted into the lactone as in example 1 and lyophilized. Theoxidation took place quantitatively (yield >99%). It was also possibleby this method to oxidize low molecular weight HES (e.g. HES-10 kDa,HES-25 kDa, HES-40 kDa) and higher molecular weight HES species.

EXAMPLE 3

Coupling of Selectively Oxidized High Molecular Weight HES (ox-HES-130kDa) to Human Serum Albumin (HSA)

4.3 g of ox-HES-130 kDa and 200 mg of HSA (Sigma, Taufkirchen) werecompletely dissolved in water by gentle heating in a round-bottom flaskwith magnetic stirrer. 30 mg of ethyldimethylaminopropylcarbodiimide(EDC), dissolved in water, were added to this solution. After stirringvery moderately for 2 h, a second portion of 30 mg of EDC was added.After stirring very moderately for a further two hours, a third portionof 40 mg of the carbodiimide was added. The reaction mixture was leftunder these conditions overnight, dialyzed against distilled water for15 h and lyophilized. The success of the coupling was demonstrated bygel permeation chromatography, SDS-PAGE and carbohydrate-specificstaining (Glyco-Dig kit from Roche-Boehringer, Basle) after blottingonto a PVDF membrane. The yield of coupling product was about 90%.

EXAMPLE 4

Coupling of Selectively Oxidized Low Molecular Weight HES (ox-HES-10kDa) to Human Serum Albumin (HSA)

7.4 g of ox-HES-10 kDa and 50 mg of HSA were completely dissolved inwater in a round-bottom flask with magnetic stirrer. The reaction wascarried out by the method described above for high molecular weight HES,adding a total of 282 mg of EDC in three aliquots. The reaction mixturewas likewise dialyzed and lyophilized as described above. Analysis (asabove) showed the coupling product was obtained, but the yields weresomewhat lower than in the coupling with high molecular weight ox-HES.

EXAMPLE 5

Coupling of ox-HES-130 kDa to Myoglobin (Mb)

4.3 g of ox-HES-130 kDa were completely dissolved in water (6-7 ml), andthen 100 mg of Mb (Sigma, Taufkirchen), dissolved in 10 ml of 0.1 Mphosphate buffer (pH 7.0), were added. The coupling reaction was startedby adding 30 mg of EDC. Addition of EDC was repeated every 2 hours untila total of 90 mg of the carbodiimide had been consumed. The reactionmixture was then dialyzed against 50 mM phosphate buffer, pH 7.0, andlyophilized. GPC showed a definite product peak, which was detected inthe hold-up volume at 450 nm. It was possible to calculate a couplingyield of 88% from this. The oxygen-binding capacity of the hesylatedmyoglobin was about 76% of the binding capacity of unmodified Mb.

EXAMPLE 6

Coupling of ox-HES-10 kDa to Superoxide Dismutase (SOD)

One part by volume of an aqueous solution of ox-HES-10 kDa (1.05 g/ml)was incubated with one part by volume of a 7 mg/ml SOD solution (Sigma,Taufkirchen) in 50 mM phosphate buffer, pH 7.6, at room temperature. Thecoupling reaction was initiated by adding 280 mg of EDC in 5 portionsover a period of 24 h. The progress of the reaction was followed by GPCanalysis in phosphate buffer and detection at 280 nm. After 24 h, 81% ofthe protein were found in the higher molecular weight region of theseparating column, and the reaction was stopped after this time. Thereaction mixture was subjected to a diafiltration with a 30 kDa membraneand then lyophilized. Mass spectrometric analysis of the product showedan average molar ratio of HES to protein of about 3:1.

EXAMPLE 7

Coupling of ox-HES-130 kDa to Streptokinase (SK)

3.8 kg of ox-HES-130 kDa were dissolved together with 35 mg ofstreptokinase (Sigma, Taufkirchen) in the minimum amount of 50 mMphosphate buffer, pH 7.2. At room temperature, 46.5 mg of EDC and 20 mgof 1-hydroxybenzotriazole hydrate (HOBt) were added, and reaction wasmaintained with gentle stirring for a total of 24 h. After dialysis andfreeze drying, about 78% of the protein were found as HES conjugate byGPC analysis. In the SDS-PAGE with silver staining, a distinct increasein the molecular mass of the streptokinase was observable. In parallelwith this, carbohydrate structures were unambiguously detectable in thehigh molecular waveband with the digoxigenin method.

EXAMPLE 8

Coupling of ox-HES-130 kDa to Human Interleukin-1 (IL-2)

45 mg of ox-HES-130 kDa were completely dissolved in 0.5 ml of 50 mM Naphosphate buffer, pH 6.5, with gentle heating. After addition of 0.25 mgof human IL-2 (Sigma, Taufkirchen), which made the solution opaque, themixture was stirred at room temperature for 4-6 h. Then 5 mg of EDC wereadded in 4 portions with a time difference of 2 h for each, and stirringwas continued overnight, resulting in a clear solution. GPC analysisrevealed a coupling yield of about 65%.

EXAMPLE 9

Coupling of ox-HES-25 kDa to Human Tumor Necrosis Factor α (TNFα)

0.3 mg of hTNFα (Sigma, Taufkirchen) were added to 86 mg of ox-HES-25kDa in about 0.4 ml of 0.1 M phosphate buffer (pH 7.0). The cloudysolution was stirred for about 2 h before 1 mg of EDC and 0.5 mg of HOBtwere added. Stirring was continued for about 6 h, with the solutionbecoming clear during the reaction time. The coupling product wasisolated by ultrafiltration and freeze drying and analyzed by GPC anddetection at 280 nm. A coupling yield of approximately 74% was found inthis case.

EXAMPLE 10

Coupling of ox-HES-130 kDa to Glucagon-Like Peptide (GLP-1)

7.4 g of ox-HES-130 kDa were dissolved in a minimum volume of water byheating and gentle stirring. A solution of 10 mg of GLP-1 in the amideform (Bachem, Switzerland) in 50 mM phosphate buffer, pH 7.4, was addedby pipette. The reaction was started by adding 35 mg of EDC and wascautiously stirred for 2 h. This was repeated 2× more because, afterthis time, a peptide peak was no longer evident in the GPC analysis at280 nm, i.e. approximately complete conversion to the coupling producthad taken place. This coupling product was diafiltered using a 30 kDamembrane and lyophilized from phosphate buffer solution. It was possibleto conclude from the results of a MALDI mass spectroscopy that thestoichiometry between peptide and HES was 1:1.

EXAMPLE 11

Coupling of High Molecular Weight HES (HES-130 kDa) to Human SerumAlbumin (HSA)

9.75 g of HES-130 KD were completely dissolved in water (6-7 ml), andthen 50 mg of HSA, dissolved in 1 ml of 0.1 M phosphate buffer (pH 7.4)were added. The reaction mixture was stirred with a magnetic stirrer.The solution was then mixed with NaBH₃CN (50-70 mg) and stirred gentlyfor a few minutes. The solution was further stirred for 15 minutes everytwo hours. Then a further aliquot of NaBH₃CN (about 50 mg) was added. Atthe end (after a reaction time of almost 36 h), a total amount of 285 mgof NaBH₃CN had been employed. The solution was then dialyzed andlyophilized. Analysis took place as described in example 4. The couplingefficiency was about 65%.

EXAMPLE 12

Coupling of Low Molecular Weight HES (HES-10 kDa) to Human Serum Albumin(HSA)

4.5 g of HES were completely dissolved in water (4-5 ml) and 50 mg ofHSA, dissolved in 1 ml of 0.1 M phosphate buffer (pH 7.4) were added.When the solution was clear, if necessary effected by stirring with amagnetic stirrer, NaBH₄ (50-70 mg) was added and mixed in with gentlestirring. The solution was left to stand without stirring for two hoursand then stirred for 15 minutes every two hours as for the reaction withhigh molecular weight HES. When the solution no longer showed anybubbles (H₂ evolution), a further aliquot of NaBH₄ (about 50 mg) wasadded. At the end, a total amount of 180 mg of NaBH₄ had been employed.The solution was then dialyzed and lyophilized. Analysis took place bygel permeation chromatography (GPC), and the yield was about 15%.

EXAMPLE 13

Coupling of HES-40 kDa to Asparaginase

3.0 g of HES-40 kDa were completely dissolved in water (about 4 ml). Asolution of 80 mg of asparaginase (Sigma, Taufkirchen) in 6 ml of 0.1 Mborate buffer, pH 9.0, were added thereto and stirred until the reactionmixture was clear. The temperature was then raised to 37° C. and, after2 h, about 50 mg of NaBH₃CN were added. This reaction cycle was repeated3× more. The product was worked up by dialyzing the reaction mixtureagainst 0.1 M phosphate buffer, pH 7.4. The yield of coupling productwas about 61%, and about 73% of the asparaginase activity wasrecoverable.

EXAMPLE 14

Coupling of HES-130 kDa to Human Interleukin-2 (IL-2)

50 mg of HES-130 kDa were completely dissolved in water (about 0.2 ml).A suspension of 0.25 mg of human IL-2 (Sigma, Taufkirchen) in 0.2 ml of0.1 M borate buffer, pH 9.0, was added thereto and stirred until thereaction mixture was clear (4 h). 1 mg portions of NaBH₃CN were added atintervals each of 4 h, and stirring was continued. After a furtherreaction time of 24 h, the mixture was dialyzed against 0.1 M phosphatebuffer, pH 7.4 and lyophilized. The yield of coupling product was about42% according to GPC analysis.

EXAMPLE 15

Coupling of HES-130 kDa to Insulin

4.0 g of HES-130 kDa were completely dissolved in water (about 6 ml). 55mg of insulin from bovine pancreas (Sigma, Taufkirchen) in 7.5 ml of 0.1M borate buffer (pH 9.0), were added thereto and stirred at 37° C. forabout 24 h. The reducing agent NaBH₃CN (60 mg in 30 ml) was slowly addeddropwise over a period of 8 h. The reaction mixture was then stirred fora further 24 h and freed of faults and unreacted reagents byultrafiltration (30 ). Lyophilization resulted in a stable couplingproduct. About 55% of the insulin employed was recovered as HESconjugate.

EXAMPLE 16

Coupling of ox-HES-130 kDa to Superoxide Dismutase (SOD)

130 mg of ox-HES-130 were completely dissolved in 6 ml of PBS pH 6, andthen 10 mg of SOD (Roche, Mannheim) dissolved in 1 ml of PBS pH 6 wereadded. The coupling reaction was started by adding 10 mg of EDC.Addition of EDC was repeated every 3 h until 39 mg of the carbodiimidehad been consumed. The reaction was monitored by GPC at 258 nm. After 24h, 50% of the protein were found in the high molecular weight region ofthe separating column, and the reaction was stopped. The reactionmixture was dialyzed against 25 mM phosphate buffer pH 7.2 andlyophilized. The SOD activity was 95% of the initial activity.Determination of the mass distribution of HES protein samples by coupledGPC-light scattering revealed a molar ratio of HES to protein of 1:1.

EXAMPLE 17

Coupling of ox-HES 70 kDa to Glucagon

Glucagon (66×10⁻⁹ mol, 0.23 mg), oxHES 70 kDa (6.6×10⁻⁶ mol, 123 mg)were dissolved in phosphate buffer (1 ml, pH 5) in a round-bottom flask.26 mg of EDC were added in 10 portions at intervals of 1 h. After areaction time of 24 h, the reaction was stopped by adding 10 ml ofwater. The coupling product was purified by after dialysis against waterby GPC and ion exchange chromatography. Freeze drying resulted in 88 mgof white coupling product (73%).

1. A hydroxyethylstarch-protein conjugate, characterized in that thebinding interaction between the hydroxyethylstarch molecule and theprotein is a single covalent bonding which is the result of a couplingreaction between (i) the terminal aldehyde group of thehydroxyethylstarch molecule and (ii) a primary amino group of theprotein to form a Schiff's base.
 2. The conjugate as claimed in claim 1,characterized in that the covalent bonding is an amine linkage which isthe result of a reduction of the Schiff's base to the amine.
 3. Theconjugate as claimed in claim 1, characterized in that thehydroxyethylstarch molecule has a molecular weight in the range fromabout 4 to about 1000 kDa.
 4. The conjugate as claimed in claim 3,characterized in that the hydroxyethylstarch molecule has a molecularweight of about 4 to about 50 kDa.
 5. The conjugate as claimed in claim3, characterized in that the hydroxyethylstarch molecule has a molecularweight of about 70 to about 1000 kDa.
 6. The conjugate as claimed inclaim 5, characterized in that the hydroxyethylstarch molecule has amolecular weight of about 130 kDa.
 7. The conjugate as claimed in claim1, characterized in that the hydroxyethylstarch molecule has a degree ofsubstitution of about 0.3 to about 0.7.
 8. The conjugate as claimed inclaim 1, characterized in that the hydroxyethylstarch molecule has aratio of C₂ to C₆ substitution of from 8 to
 12. 9. The conjugate asclaimed in claim 1, characterized in that the protein has a regulatoryor catalytic function, a signal transmitting or transport function or afunction in the immune response or induction of an immune response. 10.The conjugate as claimed in claim 9, characterized in that the proteinis selected from the group consisting of enzymes, antibodies, antigens,transport proteins, bioadhesion proteins, hormones and prohormones,growth factors and growth factor receptors, cytokines, receptors,suppressors, activators, and inhibitors.
 11. The conjugate as claimed inclaim 9, characterized in that the protein is α-, β- or γ-interferon, aninterleukin, a serum protein, erythropoietin, myoglobin, hemoglobin, aplasminogen activator, BCGF, BDGF, EGF, FGF, NGF, PDGF, BDNF, CNTF,TGF-α, TGF-β, a colony-stimulating factor, a BMP, somatomedin,somatotropin, somatostatin, insulin, gonadotropin, α-MSH, triptorelin,prolactin, calcitonin, glucagon, a glucagon-like peptide, exendin,leptin, gastrin, secretin, an integrmn, a hypothalamus hormone, athyroid hormone, a growth hormone, LH, FSH, a pigmentary hormone, TNF-αor TNF-β, hirudin, a lipoprotein or apolipoprotein, an oligolysineprotein, an RGD protein, a lectin or ricin, bee venom or a snake venom,an immunotoxin, ragweed allergen, antigen E, an immunoglobulin, or areceptor for one of these proteins.
 12. The conjugate as claimed inclaim 9, characterized in that the protein is an enzyme which isselected from the group consisting of an asparaginase, arginase,arginine deaminase, adenosine deaminase, glutaminase,glutaminase-asparaginase, phenylalanine ammonia-lyase, tryptophanase,tyrosinase, superoxide dismutase, endotoxinase, catalase, peroxidase,kallikrein, trypsin, chymotrypsin, elastase, thermolysin, a lipase,unease, adenosine diphosphatase, purine-nucleoside phosphorylase,bilirubin oxidase, glucose oxidase, glucodase, gluconate oxidase,galactosidase, glucocerebrosidase, glucuronidase, hyaluronidase, tissuefactor, a tissue plasminogen activator, streptokinase, urokinase, an MAPkinase, DNAse, RNAse, and lactoferrin.
 13. A pharmaceutical compositioncomprising an effective amount of a conjugate as claimed in claim 1 anda pharmaceutically acceptable carrier and, where appropriate, furtherexcipients and active ingredients.
 14. A method for preparing ahydroxyethvlstarch-protein conjugate in which the binding interactionbetween the hydroxyethylstarch molecule and the protein is a singlecovalent bonding which is the result of a coupling reaction between (i)the terminal aldehyde group of the hydroxyethylstarch molecule and (ii)a primary amino group of the protein to form a Schiff's base,characterized in that the coupling reaction is carried out in aqueoussolution between the terminal aldehyde group of the hydroxyethylstarchmolecule and a primary amino group of the protein.
 15. The method asclaimed in claim 14, characterized in that the reaction medium of thecoupling reaction is water or a mixture of water and an organic solvent,where the water content of the mixture is at least 80%.
 16. The methodas claimed in claim 14, characterized in that the terminal aldehydegroup of the hydroxyethylstarch molecule is coupled to a primary aminogroup of the protein to form a Schiff's base, and the formed Schiff'sbase is reduced to the amine, so that the hydroxyethylstarch molecule islinked to the protein by an amine linkage.
 17. The method as claimed inclaim 16, characterized in that both coupling and reduction take placein aqueous solution.
 18. The method as claimed in claim 16,characterized in that the reducing agent is sodium borohydride, sodiumcyanoborohydride or an organic boron complex.
 19. The method as claimedin claim 16, characterized in that the coupling and reduction reactionsare carried out simultaneously.